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Published on: September 2, 2025
Augmented real-time navigation with critical structure proximity alerts for endoscopic skull base surgery
Benjamin J Dixon1, Michael J Daly, Harley Chan
1Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Melbourne, Australia; Department of Surgery, University of Melbourne, St. Vincent's Hospital and Peter MacCallum Cancer Institute, Melbourne, Australia.
The novel Localized Intraoperative Virtual Endoscopy (LIVE)-Image-Guided Surgery (IGS) system reduced surgeon workload and improved orientation during preclinical skull base surgery. This advanced IGS prototype offers intuitive feedback and enhanced safety for complex procedures.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Navigation
Background:
- Image-guided surgery (IGS) is crucial for cranial base surgery, aiding orientation and precision.
- A new localized intraoperative virtual endoscopy (LIVE)-IGS prototype was developed to enhance surgical performance.
- The LIVE-IGS system integrates real-time instrument tracking, proximity alerts, 3D virtual endoscopy, and intraoperative cone-beam CT updates.
Purpose of the Study:
- To evaluate the performance of the LIVE-IGS prototype in a preclinical setting.
- To compare the LIVE-IGS system against conventional IGS during skull base procedures.
- To assess surgeon workload and qualitative feedback on the LIVE-IGS system.
Main Methods:
- A randomized-controlled trial with qualitative analysis was conducted.
- Seven skull base surgeons performed endoscopic transclival approaches on 14 cadaver specimens.
- Surgeons used both the LIVE-IGS and conventional IGS systems, with workload assessed via NASA-TLX scores and semistructured interviews.
Main Results:
- The LIVE-IGS system significantly reduced surgeon mental demand, effort, and frustration compared to conventional navigation (P < .05).
- The system interface was perceived as intuitive, particularly in complex scenarios with limited landmarks and critical structure proximity.
- Auditory icons for proximity alerts effectively informed surgeons while minimizing distraction.
Conclusions:
- The LIVE-IGS system offers accurate, intuitive, and dynamic feedback for surgeons.
- Further refinements in proximity alerts and visualization can improve orientation and reduce distraction.
- The system is progressing to a prospective clinical trial for skull base surgery.
